Surgical treatment of infantile hemangioma in a multidisciplinary vascular anomalies clinic

Objective(1) Discuss indications for surgical treatment of infantile hemangioma (IH); (2) describe outcomes, management of complications and long term surveillance of surgically treated IH.Study designRetrospective.Subjects and methodsThe charts of children seen in a dedicated vascular anomalies center at a tertiary pediatric hospital were reviewed.ResultsOut of 1012 patients diagnosed with IH over 27 months, 92 patients, predominantly caucasian female, with an average age of 36 months, underwent surgery for 94 lesions. Head and neck lesions accounted for 67% of the population and 51 lesions were located on the face. Surgical indications included bleeding, functional impairment, ulceration and cosmetic disfigurement. Mean surface area was 7.75 cm2. Although lesions requiring additional procedures were larger (median 5.5 cm2) than single-stage excisions, this difference was not statistically significant (P = 0.09). Head and neck lesions were more likely to require multiple modality treatment (P = 0.003). There was no identified objective criteria to predict head and neck lesions that are more likely to be associated post-operative complications.ConclusionsMost IH do not require treatment. The majority of infantile hemangioma occurred on the head and neck. When significant functional impairment, ulceration, bleeding, cosmetic deformity is encountered or anticipated, surgical therapy can be performed at any clinical phase with few complications and favorable outcomes.